Endoscopic Lithotripsy of bile duct stones using a Pulsed-Dye Laser

The development of EST and percutaneous transhepatic catheterization techniques and recent improvements in fiberoptic cholangioscopy have allowed for non-surgical removal of biliary stones. Several centers have reported success in bile stone fragmentation and removal via percutaneously or via transcapillary using various techniques (mechanical stone extraction, ultrasonic lithotripsy, electrohydrauric lithotripsy, Nd:YAG laser). However, some reports have suggested the possibility of bile duct damage being associated with EHL or Nd:YAG laser treatment.In our hospital, almost all CBD stones were extracted using a basket catheter or mechanical lithotripter. But 3% of the patients have undergone EHL (guided by PTCS or POCS). In this report, 2 patients with intrahepatic bile duct stones and 6 with large common bile duct stones were treated successfully with a pulsed dye laser. Lithotripsy was performed under direct vision by cholangioscopy (4 cases) and peroral cholangioscopy (4 cases). Practically speaking, the PTCS procedure was easier than POCS for guiding pulsed laser lithotripsy. There were no serious complications. All stones were satisfactorily fragmented in one session of pulsed laser lithotripsy, except one case (with intrahepatic bile duct stones combined with CBD stones).Pulsed dye laser will make endoscopic lithotripsy safer, more effective and less time consuming.